Heterotopic Triplet Pregnancy Research Articles

Heterotopic Triplet Pregnancy after Double Frozen Embryo Transfer Resulting in Delivery of Healthy Twins at Term: A Case Report

Background: Sonographic visualization of intrauterine pregnancy after multiple embryo transfers does not preclude the coexistence of an ectopic pregnancy, which should be excluded routinely. Heterotopic pregnancy carries high morbidity and mortality. Therefore, it needs high index of suspicion to diagnose and manage accordingly. Case Presentation: Our case reports a 39-year-old woman who presented with heterotopic triplet pregnancy at 5 weeks and 5 days of gestation. It resulted in a successful delivery of intrauterine monozygotic twins at 37 weeks. This pregnancy is an outcome of ICSI treatment due to low ovarian reserve. Only two embryos were obtained through the protocol and double frozen embryo transfer was done afterwards. Tubal pregnancy was successfully managed expectantly. Conclusion: Our case highlights the importance of early surveillance and close monitoring of patients undergoing multiple embryo transfers. Thus, keeping the possibility of heterotopic pregnancy in mind after ART cannot be over-emphasized.

Heterotopic triplet pregnancy after in vitro fertilization and intracytoplasmatic sperm injection complicated with ovarian hyperstimulation syndrome single twin fetal demise and cervical incompetence: a successful obstetrical outcome

Spontaneous heterotopic triplet pregnancy (HTP) was formerly considered to be extremely rare. Recently, the broad use of assisted reproductive techniques to assist infertile couples, has contributed to the constant rise of non-spontaneous heterotopic triplets. A case of 38-year-old woman who underwent in vitro fertilization (IVF) and intracytoplasmatic sperm injection (ICSI) is presented. A series of complications appeared and were treated successfully. Although this situation could be life threatening and should alert the medical community, misdiagnosis is still present. The clinicians need to be aware that after IVF procedures, one or more complications might occur. In those cases, early diagnosis and surgical or conservative intervention is of paramount importance.

Spontaneous Heterotopic Triplet Pregnancy with Tubal Ruptured Ectopic Gestation

Spontaneous Heterotopic Triplet Pregnancy with Tubal Ruptured Ectopic Gestation

Spontaneous heterotopic triplet pregnancy with intrauterine monochorionic-monoamnionic twins

Abstract Heterotopic pregnancies are an unusual phenomenon, which have recently become more prevalent with assisted reproductive technologies (ART). Triplets that are part of a heterotopic pregnancy are exceedingly rare. Here, we describe a case of a woman who presented at 15+1 weeks of gestational age with a known monochorionic-monoamniotic intrauterine pregnancy with several days of abdominal pain with an otherwise unremarkable gastrointestinal (GI) assessment. Salpingectomy was performed, and pathology revealed chorionic villi within the fallopian tube consistent with a heterotopic triplet pregnancy. This pregnancy was conceived spontaneously. Even without the prior use of ART, physicians need to be aware of the risk of heterotopic pregnancy in a patient with a known twin gestation. In addition, this case highlights how heterotopic triplets can present even within the second trimester.

Heterotopic triplet pregnancy with bilateral tubal ectopic post-IVF–ICSI of two 12-cell embryos

A heterotopic pregnancy is the coexistence of intrauterine and extrauterine pregnancy. It can be as rare as 1:30,000 in spontaneous pregnancies but can be as high as 1:100 following artificial reproductive techniques (ART) [1]. Bilateral tubal ectopic pregnancy is another extremely rare clinical condition, with an estimated prevalence of 1:200,000 in spontaneous pregnancies [2]. It accounts for one in 750 to one in 1580 ectopic pregnancies [3]. Heterotopic triplets are even more uncommon, and cases with bilateral tubal ectopics and coexisting intrauterine pregnancy are limited, if not unheard of. To add to the rarity of these clinical conditions is when there is a heterotopic triplet pregnancy with bilateral tubal ectopics resulting from the transfer of only two embryos as is explained in the case of our patient. Our patient was a 37-year-old woman with unexplained secondary subfertility of 6 years (gravida 2, para 0 þ 1 miscarriage) with a confirmed intrauterine pregnancy after her first attempt of in vitro fertilization (IVF). She had controlled minimal ovarian stimulation for a total of 10 days. Four mature eggs were retrieved on Day 11, and intracytoplasmic sperm injection was performed on all the eggs. Only two embryos at the 12-cell stage were found suitable for transfer. The patient was prescribed with oral dydrogesterone 8 hourly for luteal support. The Day-10 posttransfer serum b hCG level confirmed a successful implantation, and she was scheduled for follow up. Unfortunately, she presented herself

Spontaneous Heterotopic Triplet Pregnancy With Tubal Rupture: A Case Report and Literature Review.

The recent increase in heterotopic pregnancies has been largely attributed to the increased use of assisted reproduction technologies. We report the rare case of a multiparous woman with a spontaneous conception resulting in a triplet heterotopic pregnancy: a twin intrauterine pregnancy and a single right tubal ectopic pregnancy. Heterotopic pregnancy is a rare and potentially life-threatening condition in which simultaneous gestations occur at 2 or more implantation sites. It is infrequent in natural conception cycles, occurring in 1:30 000 pregnancies. However, the prevalence is rising with the increased use of assisted reproduction techniques to that of 1:100 to 1:500 in these patient subgroups, highlighting the need to incorporate it into a clinician’s diagnostic algorithm.

Heterotopic Triplet Pregnancy after In Vitro Fertilization with Favorable Outcome of the Intrauterine Twin Pregnancy Subsequent to Surgical Treatment of the Tubal Pregnancy

Heterotopic triplet pregnancy is an exceptionally rare medical condition. The broad use of assisted reproductive technologies has contributed to the increase of ectopic and subsequently heterotopic pregnancy rate, masking a life-threatening condition for the gravid and the intrauterine pregnancy. We describe a case of a woman with heterotopic triplets at 9+4 gestational week following transfer of three embryos obtained by in vitro fertilization techniques. The ectopic tubal pregnancy was ruptured and salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed to the delivery by cesarean section of two healthy twins at 36+2 gestational age. Heterotopic triplets with tubal ectopic are a special diagnostic and therapeutic challenge for the obstetrician. High index of suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.

Heterotopic triplet pregnancy with an intrauterine, a tubal, and a cervical gestation following in vitro fertilization and embryo transfer

Heterotopic triplet pregnancy with an intrauterine, a tubal, and a cervical gestation following in vitro fertilization and embryo transfer

Heterotopic triplet pregnancy: report of a patient with remnant tubal ectopic and intrauterine twin pregnancy after frozen‐thawed embryo transfer

A case of heterotopic triplet pregnancy after frozen-thawed embryo transfer is presented. The patient conceived after transfer of three frozen-thawed embryos at a fertility clinic where she had previously undergone laparoscopic left salpingectomy due to pyosalpinx. Approximately 4 weeks after the embryo transfer, she presented with a complaint of abnormal genital bleeding and was diagnosed by ultrasound as having a dichorionic twin pregnancy. One week later, she was referred to our hospital because of lower abdominal pain. Hematoperitoneum was suspected based on findings of low blood pressure and tachycardia. Diagnostic emergent laparoscopy demonstrated an ectopic pregnancy in the remnant isthmic portion of the left tube. Laparoscopic excision of the remnant fallopian tube was performed, but the procedure resulted in early-pregnancy loss of one of the twins. The risk of heterotopic pregnancy is not small under assisted reproductive technology. Attention should be paid to the risk of tubal pregnancy after transferring more than two embryos or controlled ovarian hyperstimulation, even after salpingectomy has been performed.

P02.11: Conservative management of a complicated heterotopic triplet pregnancy with a cornual monochorionic twin pair

A 29 year old G5 P0040 presented for evaluation of a multifetal gestation at 8 postmenstrual weeks. The patient had an extensive obstetrical history significant for prior right tubal pregnancy and right salpingectomy, two 1st trimester miscarriages, and a subsequent IVF pregnancy resulting in a simultaneous bilateral, ovarian heterotopic pregnancy, which was managed by laparoscopic resections and left salpingectomy. The index pregnancy was assisted by IVF/ET. Two frozen embryos were transferred. Ultrasound detected a heterotopic triplet gestation. 2D ultrasound and 3D reconstruction were instrumental in depicting the location of the three embryos. This was significant for an intrauterine singleton, and a right cornual monochorionic diamniotic twin pair. Extensive counseling was performed regarding the different management options. Given that this was a highly desired pregnancy and that a normally implanted intrauterine singleton was seen, selective reduction of the cornual twin pair was performed by transcervical ultrasound guided KCl injection. Following the procedure, serial clinical and sonographic evaluation were performed. This surveillance revealed increased amount of fluid accumulating in the cul-de-sac, suggesting bleeding from the cornual pregnancy. The patient therefore, underwent laparotomy in which evacuation of the hemiperitoneum and cornual pregnancy were followed by closure of the cornual gestations’ bed. During the surgery, caution was exercised using gentle handling of the uterus to maintain the intrauterine singleton embryo intact. Ultrasound demonstrated a reasonably large distance from it to the affected cornua which was interpreted as a positive prognostic factor. After recovery, outpatient surveillance confirmed an otherwise uncomplicated prenatal course. Scheduled cesarean delivery was performed at 37 weeks. This unusual case highlights the efforts to conservatively manage this extremely rare and complicated heterotopic pregnancy.

Heterotopic triplet pregnancy (twin tubal) in a natural cycle with tubal rupture: Case report and review of the literature

The incidence of heterotopic/ectopic pregnancy has risen in recent years, largely due to more frequent use of ovulatory medicine and increased incidence of pelvic inflammatory disease. In a natural cycle, it is a very rare event. Most heterotopic/ectopic pregnancies are localized in the uterine tube and, usually, it is diagnosed when symptoms develop. We report the case of a 37 year-old, gravida 2, para 0, abortion 1 woman with no known risk factors for heterotopic pregnancy. The patient attended the emergency department because of acute abdominal pain. She was evaluated in our department and a heterotopic twin pregnancy in the tube was diagnosed by transvaginal sonography. Intrauterine pregnancy with positive fetal cardiac activity at 9 weeks of gestation according to crown-rump length measurement was detected. Laparotomy was carried out because of acute abdominal syndrome. Right ruptured tubal ectopic/heterotopic pregnancy and hemoperitoneum were diagnosed. Right salpingectomy was carried out. Pathology revealed monochorionic twin tubal pregnancy. In a review of the literature, this is first case of twin tubal pregnancy in one uterine tube. In conclusion, heterotopic pregnancy in twin form in the uterine tube is possible in natural cycles. Intrauterine pregnancy does not exclude extrauterine pregnancy in natural cycles.

Case of progressive intrauterine twin pregnancy after surgical treatment of cornual pregnancy

To report on a case of heterotopic triplet pregnancy after in utero transfer of three embryos obtained by in vitro fertilization (IVF), with progression of the intrauterine twin pregnancy after resection of the cornual pregnancy. Technique and instrumentation. Département de Médecine de la Reproduction, Hôpital Edouard Herriot, Lyon, France. A 32-year-old woman, nulliparous with primary infertility for the previous 12 years due to mixed causes (tubal and male infertility). Diagnosis by ultrasound scan and per-laparoscopic confirmation, followed by resection of the cornual pregnancy by laparotomy. Ultrasound diagnosis and follow-up of the pregnancy. Delivery. Complete ablation of the cornual pregnancy. Progression of the intrauterine twin pregnancy without difficulties until 31 weeks of gestation. Cesarean upon onset of labor. Birth of two living infants. The scar of the uterine horn, examined during the caesarean, was thick and solid. The early diagnosis and surgical treatment of an ectopic pregnancy permitted the development of the intrauterine pregnancy. The risk of heterotopic pregnancy is increased by medical techniques that facilitate procreation. This risk is directly related to the number of embryos transferred. In the case of heterotopic pregnancy, the rate of progressive intrauterine pregnancy after treatment of the ectopic pregnancy is encouraging.

Bromocriptine-Induced Heterotopic Triplet Pregnancy: Bilateral Tubal and Intrauterine Pregnancy in a Patient with Pituitary Adenoma

A heterotopic pregnancy is the coexistence of one or more ectopic and a single or multiple eutopic pregnancy. Heterotopic pregnancy currently occurs in approximately 1 of 7000 spontaneous pregnancies. However, artificial reproductive techniques increase the incidence to 1%. Coexisting bilateral tubal and an intrauterine pregnancy is a rare condition. We present a case of a combined bilateral ectopic and intrauterine pregnancy in a patient with a pituitary adenoma who was managed with bromocriptine. (J GYNECOL SURG 22:123)

Triplet Heterotopic Pregnancy After Gonadotropin Stimulation and Intrauterine Insemination Diagnosed at Laparoscopy: A Case Report

Heterotopic pregnancy has been traditionally considered a rare event; however, with the use of assisted reproductive technology, the incidence of heterotopic pregnancies is increasing. Diagnosing a heterotopic pregnancy can be challenging. This report describes a 30-year-old female at 11 weeks' gestation with an intrauterine twin pregnancy after gonadotropin stimulation and intrauterine insemination who presented complaining of left lower quadrant abdominal pain with constipation and cramps. The patient was empirically treated for diverticulitis but failed to respond to therapy. A heterotopic triplet pregnancy was ultimately diagnosed at laparoscopy. Heterotopic pregnancy must be considered in the differential diagnosis of abdominal pain in the first trimester, especially in patients who conceived by means of assisted reproductive technology. Surgical treatment is the most frequently used method of treatment.

Case report: Heterotopic triplet pregnancy with bilateral tubal and intrauterine pregnancy after IVF

Heterotopic pregnancy in a spontaneous cycle is rare, but the incidence increases with the introduction of assisted reproductive technologies. This report describes a case of combined bilateral tubal and intrauterine pregnancy after IVF and embryo transfer. The diagnostic and therapeutic problems will be discussed both in terms of the case report and the literature. Heterotopic pregnancies after IVF and resulting problems are further reasons to encourage the transfer of only one embryo. This could be difficult to achieve without simultaneously decreasing pregnancy rates, as embryo selection is not permitted in Germany.

Heterotopic triplet pregnancy: report and video of a case of a ruptured tubal implantation with living embryo concurrent with an intrauterine twin gestation

This report presents a case of triplet heterotopic gestation after intracytoplasmic sperm injection (ICSI)-IVF treatment, with a left ruptured ectopic tubal implantation with a living embryo and successful outcome of the concurrent intrauterine twin gestation. A couple whose infertility was caused by oligoasthenozoospermia was referred for ICSI treatment. Three good quality embryos were transferred at the request of the patient. Early gestational control was performed by ultrasound at weeks 5 and 7 of gestation. The patient reported to the centre during week 7 with severe abdominal pain and with signs of peritoneal irritation. Transvaginal ultrasound revealed an extra-uterine ruptured implantantion. During the concomitantly performed laparoscopic procedure, a living embryo was observed after opening the extra-uterine embryonic sac. Heartbeat activity was present and lasted for 5 min after surgical resection of the tubal implantation. The patient was discharged from hospital without complications. The intrauterine twin gestation was not affected and two healthy infants were born at week 38 of gestation. Heterotopic pregnancy should be ruled out in patients submitted to IVF–embryo transfer, although no predisposing factors are present in some cases. Precise diagnosis may be delayed due to some important characteristics of the IVF–embryo transfer treatment. Nevertheless, this condition should be diagnosed by ultrasound before tubal rupture to avoid obvious complications. Laparoscopy remains the gold standard for diagnosis and treatment in these cases. The presentation of the heterotopic pregnancy was recorded on video and may be viewed on the internet at www.rbmonline.com/Article/710.

Case Report of a Heterotopic Triplet and Tubal Pregnancy With Follow-Up Evaluation

The incidence of heterotopic pregnancy is rising as more patients use assisted reproduction techniques to conceive. The authors report a case of a heterotopic triplet tubal pregnancy that was managed successfully without surgical intervenion.